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Integration and Coordination: Nutrition and Food Security

Food and nutrition support is a critical component of comprehensive HIV/AIDS care and treatment as well as effective TB treatment. For many PLWHA, the infection causes or aggravates malnutrition through reduced food intake, increased energy needs and impaired nutrient absorption. Malnutrition hastens the progression of HIV by further weakening the immune system, increasing susceptibility to opportunistic infections and reducing the effectiveness of treatment. Food and nutrition support breaks this vicious cycle by improving management of symptoms, nutritional status, response to treatment, and quality of life and productivity.

Food and nutrition services are essential as part of a comprehensive response to the epidemic. With the recent G8 and G20 commitments to improve food security at L'Aquila, as well as the USG Global Hunger and Food Security initiative, opportunities exist to increase coordination of nutrition, food security, and PEPFAR programs. Possible linkages include activities around nutrition surveillance at the household level, development of specialized food products to combat undernutrition, and livelihood assistance support.

In PEPFAR programs, food and nutrition care and support is designed to be an integral component of clinical and community services. The primary program approach for integrating nutritional care and support with care and treatment services has been Food by Prescription (FBP). Components of FBP are:

Specialized food products, including therapeutic foods, prescribed for a limited duration on the basis of clear anthropometric entry and exit eligibility criteria; and

Nutrition surveillance at the household level as a component of home-based care and other community programs to identify individuals who are chronically ill and need referrals for care.

FBP, home-based care and other PEPFAR-supported programs provide entry points and platforms to link food-insecure PLWHA and their families, including OVC, to additional food security and livelihood assistance through partners like the UN's World Food Program, United States Agency for International Development (USAID) Title II programs, and country governments.

In addition to FBP, PEPFAR is working to reach women and children in PMTCT programming. Low-resource settings may lack access to clean water for formula. PEPFAR engages in interventions to reduce postnatal mother-to-child HIV transmission and increase HIV-free survival, and supports activities that adhere to WHO guidelines around breastfeeding. Services include regular post-weaning assessment, nutrition support, early and ongoing infant feeding support and counseling, and provision of basic child survival interventions to at least 24 months of age.

With increased harmonization of PEPFAR and USG food security programming in its next phase, PEPFAR is working with countries to focus on the following areas:

Expanding Nutrition Care and Support for PLWHA

PEPFAR plans to roll out FBP in additional PEPFAR country care and treatment programs. The expansion will increase quality and expand integration with clinical services and home-based care and community programs. In addition, PEPFAR is expanding local industry capacity to manufacture and package safe, quality-assured products for FBP.

Increasing Postnatal PMTCT/HIV-Free Survival of Children

PEPFAR promotes HIV-free survival as a key goal of PMTCT programs. It is increasing linkages between PMTCT and the postnatal continuum of care with FBP, PMTCT and maternal and child health programming.

Food Security and Economic Strengthening

PEPFAR is working to integrate household food security and livelihood assessments within FBP programs. It is establishing referral systems for food commodity assistance and food security and livelihood assistance support. Through these programs, PEPFAR can identify models for livelihood assistance and longer-term food security support. By linking these models to comprehensive food security strategies, countries can reduce poverty and improve nutrition, particularly for those who are most vulnerable.